A comparison of clinical performance of primary care and traditional internal medicine residents

OBJECTIVE. TO compare primary care and traditional Internal Medicine reside nts in their adherence to preventive medicine guidelines, performance in th e management of chronic diseases, and utilization of resources. DESIGN. Prospective cohort study. SETTING. Urban Internal Medicine residency program. PARTICIPANTS. Sixteen primary care and 137 traditional Internal Medicine re sidents who took care of 6,307 patients (a total of 21,002 patient visits i n a 1-year period). MEASUREMENTS. Adherence to preventive medicine guidelines for the screening of breast cancer, cervical cancer, hypercholesterolemia, and colon cancer; admission rates among patients with asthma, chronic pulmonary disease, and diabetes mellitus; four items in the management of diabetes; and resource utilization including the costs for laboratory and radiology tests and numb er of consultations. RESULTS. Primary care residents, as compared with traditional residents, ad hered to preventive medicine guidelines for a greater proportion of their p atients for the following: breast cancer among women aged 52 to 75 years (6 1% vs. 54%, respectively, P = 0.05); cholesterol screening among patients a ged 20 to 64 years (39% vs. 33%, P = 0.007); colon cancer among patients ol der than 50 years (49% vs. 31%, P = 0.001); and cervical cancer among women aged 20 to 64 years (36% vs. 31%, P = 0.03). There were no differences in hospital admission rates for patients with diabetes or asthma. Total ambula tory tare costs for tests, procedures, consults, and office visits were gre ater far patients of primary care residents ($1,045 vs. $899, P = 0.0001), although total costs per primary care visit were similar between the two pa tient groups. CONCLUSIONS. Primary care residents more closely adhered to preventive medi cine guidelines but were similar to traditional residents in their manageme nt of chronic diseases. Patients of primary care residents had greater ambu latory care costs that were not entirely attributable to greater adherence to preventive medicine guidelines.